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    How do you measure surgical skills?

    Across surgical training levels, stress decreases with increased ability and skill, according to a study in the Journal of Surgical Education which used human perspiration as an objective indicator to assess a surgeon’s stress during surgery.

    “Evaluation of surgical residents is largely done through subjective measures, such as questionnaires and ranking systems guided by personal observations of supervising faculty,” says lead author Jacob Quick, M.D., an assistant professor of acute care surgery at the University of Missouri School of Medicine in Columbia. “Therefore, there is a lack of objective means to determine surgical competence.”

    The study authors hypothesized that stress, “analyzed by measuring electrodermal activity (EDA) of the skin during operative procedures, would reveal an objective measure of competence,” Dr. Quick tells The Aesthetic Channel.

    A total of 14 general surgery residents and five faculty physicians participated in the study. Over an 8-month period, EDA responses were measured during each of the 130 surgical procedures monitored. The results were then compared to determine common points during procedures where surgeons experienced different levels of EDA responses.

    The study found that at critical points during the procedures, the EDA of residents increased as much as 20 times more than the EDA of experienced faculty performing the same surgery.

    “The results were not surprising,” Dr. Quick says. “We saw that with progressive training changes in electrodermal activity exhibited an overall decline.”

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    Two elements, or subtypes, of EDA exist. “The first is known as a phasic response, and represents the peak stress point experienced at a specific point during task completion,” Dr. Quick says. “The second, tonic level, is indicative of the overall stress level experienced during the entire event.”

    The authors identified high competency levels, when both of these subtypes of electrodermal activity were low.

    “Ours is one of the few methods of objectively evaluating stress in relation to competence, and has the potential to provide meaningful information to aid in resident surgical education,” Dr. Quick says.

    However, Dr. Quick also points out that this type of monitoring may not become a standard training option for the foreseeable future because initial equipment costs can approach $10,000, even though the sensors are reusable.

    Meanwhile, the next step will be to add stop-action photography to further explore objective assessments, according to the researcher. The study authors are also 

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